| Phoenix Rising Family Medicine Llc | |
|
810 Commercial St Se Salem OR 97302 | |
| (971) 227-1073 | |
| Not Available |
| Full Name | Phoenix Rising Family Medicine Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 810 Commercial St Se, Salem, Oregon |
| Authorized Official Name and Position | Joel E Dupuis (MBR) |
| Authorized Official Contact | 5415566743 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Family Medicine Llc Po Box 2693 Salem OR 97308-2693 Ph: (541) 556-6743 | Phoenix Rising Family Medicine Llc 810 Commercial St Se Salem OR 97302 Ph: (971) 227-1073 |
| NPI Number | 1033654793 |
|---|---|
| Provider Enumeration Date | 01/04/2017 |
| Last Update Date | 07/31/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033654793 | NPI | - | NPPES |
| 500690272 | Medicaid | OR | |
| R185124 | Other | OR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 201505391NP-PP (Oregon) | Primary |
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